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Meta-Analysis
. 2013 Nov 21;2013(11):CD000563.
doi: 10.1002/14651858.CD000563.pub7.

Post-operative radiotherapy for ductal carcinoma in situ of the breast

Annabel Goodwin  1 , Sharon Parker, Davina Ghersi, Nicholas Wilcken
Affiliations
Meta-Analysis

Post-operative radiotherapy for ductal carcinoma in situ of the breast

Annabel Goodwin et al. Cochrane Database Syst Rev. .

Abstract

Background: The addition of radiotherapy (RT) following breast conserving surgery (BCS) was first shown to reduce the risk of ipsilateral recurrence in the treatment of invasive breast cancer. Ductal carcinoma in situ (DCIS) is a pre-invasive lesion. Recurrence of ipsilateral disease following BCS can be either DCIS or invasive breast cancer. Randomised controlled trials (RCTs) have shown that RT can reduce the risk of recurrence, but assessment of potential long-term complications from addition of RT following BSC for DCIS has not been reported for women participating in RCTs.

Objectives: To summarise the data from RCTs testing the addition of RT to BCS for treatment of DCIS to determine the balance between the benefits and harms.

Search methods: We searched the Cochrane Breast Cancer Group Specialised Register (2 June 2011), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 1), MEDLINE (2 June 2011), EMBASE (2 June 2011) and the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP; 2 June 2011). Reference lists of articles and handsearching of ASCO (2007), ESMO (2002 to 2007), and St Gallen (2005 to 2007) conferences were performed.

Selection criteria: RCTs of breast conserving surgery with and without radiotherapy in women at first diagnosis of pure ductal carcinoma in situ (no invasive disease present).

Data collection and analysis: Two authors independently assessed each potentially eligible trial for inclusion and its quality. Two authors also independently extracted data from published Kaplan-Meier analysis (survival curves) and reported summary statistics. Data were extracted and pooled for four trials. Data for planned subgroups were extracted and pooled for analysis.There were insufficient data to pool for long-term toxicity from radiotherapy.

Main results: Four RCTs involving 3925 women were identified and included in this review. All were high quality with minimal risk of bias. Three trials compared the addition of RT to BCS. One trial was a two by two factorial design comparing the use of RT and tamoxifen, each separately or together, in which participants were randomised in at least one arm. Analysis confirmed a statistically significant benefit from the addition of radiotherapy on all ipsilateral breast events (hazards ratio (HR) 0.49; 95% CI 0.41 to 0.58, P < 0.00001), ipsilateral invasive recurrence (HR 0.50; 95% CI 0.32 to 0.76, p=0.001) and ipsilateral DCIS recurrence (HR 0.61; 95% CI 0.39 to 0.95, P = 0.03). All the subgroups analysed benefited from addition of radiotherapy. No significant long-term toxicity from radiotherapy was found. No information about short-term toxicity from radiotherapy or quality of life data were reported.

Authors' conclusions: This review confirms the benefit of adding radiotherapy to breast conserving surgery for the treatment of all women diagnosed with DCIS. No long-term toxicity from use of radiotherapy was identified.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

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Forest plot of comparison: 1 Post‐operative radiotherapy versus surgery alone, outcome: 1.1 All ipsilateral recurrence.
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Forest plot of comparison: 1 Post‐operative radiotherapy versus surgery alone, outcome: 1.2 Ipsilateral Invasive recurrence.
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Forest plot of comparison: 1 Post‐operative radiotherapy versus surgery alone, outcome: 1.3 Ipsilateral DCIS recurrence.
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Forest plot of comparison: 1 Post‐operative radiotherapy versus surgery alone, outcome: 1.4 Incidence of Ipsilateral recurrence by surgical excision.
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Forest plot of comparison: 1 Post‐operative radiotherapy versus surgery alone, outcome: 1.5 Incidence of ipsilateral breast recurrence by age.
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Forest plot of comparison: 1 Post‐operative radiotherapy versus surgery alone, outcome: 1.6 Incidence of Ipsilateral Recurrence by histology.
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8
Forest plot of comparison: 1 Post‐operative radiotherapy versus surgery alone, outcome: 1.8 Size of DCIS lesion.
1.1
1.1. Analysis
Comparison 1 Post‐operative radiotherapy versus surgery alone, Outcome 1 All ipsilateral recurrence.
1.2
1.2. Analysis
Comparison 1 Post‐operative radiotherapy versus surgery alone, Outcome 2 Ipsilateral Invasive recurrence.
1.3
1.3. Analysis
Comparison 1 Post‐operative radiotherapy versus surgery alone, Outcome 3 Ipsilateral DCIS recurrence.
1.4
1.4. Analysis
Comparison 1 Post‐operative radiotherapy versus surgery alone, Outcome 4 Incidence of Ipsilateral recurrence by surgical excision.
1.5
1.5. Analysis
Comparison 1 Post‐operative radiotherapy versus surgery alone, Outcome 5 Incidence of ipsilateral breast recurrence by age.
1.6
1.6. Analysis
Comparison 1 Post‐operative radiotherapy versus surgery alone, Outcome 6 Incidence of Ipsilateral Recurrence by histology.
1.7
1.7. Analysis
Comparison 1 Post‐operative radiotherapy versus surgery alone, Outcome 7 Incidence of All Ipsilateral Recurrence.
1.8
1.8. Analysis
Comparison 1 Post‐operative radiotherapy versus surgery alone, Outcome 8 Size of DCIS lesion.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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